BEIJING, September 11, 2012 (City Weekend) — Lung cancer is the most common cancer in the world, with 1.61 million new cases diagnosed in 2008, according to the World Cancer Research Fund International. In February, the World Health Organization said that lung cancer was responsible for contributing to the most cancer-related deaths among both men and women, at 1.37 million deaths annually in 2008. While more recent statistics have been slow to trickle in, it’s safe to say that lung cancer isn’t about to relinquish its spot on these lists any time soon.
This problem is especially apparent in China. According to 2011 statistics from China’s Ministry of Health, approximately 600,000 people die of lung cancer each year. Despite the country’s rapid modernization process and many improvements in the quality of life and health care services, the lung cancer mortality rate has increased at an astounding 465 percent on the Chinese mainland in the past 30 years and, according to the Beijing Health Bureau, the lung cancer incidence rate in the capital city has jumped 60 percent over the past 10 years.
While there are a variety of factors that can contribute to lung cancer, including hereditary, behavioral and environmental factors, Dr. Derick Lau, the United Family Healthcare Group Director of Oncology at Beijing United Family Hospital and Clinics (BJU), says there’s one major factor that is the same everywhere: cigarette smoking. “Over 80 percent of lung cancer is caused by cigarette smoking.”
China is the world’s largest tobacco producer and consumer, with over 300 million smokers. In 2010, the Global Adult Tobacco Survey, which was carried out by the Chinese Center for Disease Control and Prevention in collaboration with the U.S. Centers for Disease Control and Prevention and the World Health Organization, found that 28.1 percent of adults in China were smokers—52.9 percent of men and 2.4 percent of women.
Moreover, 740 million people are exposed to second-hand smoke in China, according to the Ministry of Health, which means that smokers aren’t the only ones affected by their habit. A report by the U.S. Department of Health and Human Services states that those exposed to second-hand smoke see their chances of developing lung cancer rise by 20 to 30 percent. Although it may not be completely due to exposure to second-hand smoke, the Public Library of Science estimates that 15 percent of all cases of lung cancer occur in “never-smokers.”
Though Dr. Lau maintains that there isn’t any definitive evidence yet linking poor air quality with lung cancer, many experts are quick to make a connection. According to an official with the Beijing Health Bureau, incidences of lung cancer have continued to increase in the city, though smoking rates have not noticeably jumped.
Lung cancer 101
Cells are the most basic parts of our body. In a healthy body, cells multiply when they’re needed and die when they’re not. In the simplest definition, cancer is an uncontrolled growth of abnormal cells in the body. These cells are also called malignant cells, and can develop on just about any tissue or organ, creating a tumor.
Depending on the type and location, cancer can be detected through a variety of tests: a biopsy of a tumor, blood tests that look for chemicals, such as cancer markers, or a computerized tomography scan (CT scan). Lung cancer is most often diagnosed after a CT scan, which determines where the cancer is on the lungs, and a biopsy of the tumor, which finds malignant cells.
Dr. Lau says there are two main classes of lung cancer: small cell lung cancer and non-small cell lung cancer. Non-small cell lung cancer can be further classified as adenocarcinoma (a cancer of the epithelium, or body tissue, that originates in a gland), squamous cell lung carcinoma (a cancer of the squamous cell, a specific kind of epithelial cell) and large-cell lung carcinoma (a cancer named for the large cells that can be seen through a microscope). Adenocarcinoma often develops around the outer edges, or periphery, of the lungs, while the other two tend to be more centrally located.
Adenocarcinoma accounts for about 40 percent of cancer cases and is the most common type of lung cancer among long-term smokers as well as lifelong non-smokers. Dr. Lau points out that adenocarcinoma occurs most often in young, female Asian non-smokers. Squamous cell lung carcinoma and large-cell lung carcinoma are both highly correlated with smoking, especially for those who have smoked for over 30 years. Smaller-than-normal cells appear in small cell lung cancer. These cells tend to be highly malignant and metastatic, which means they spread into other organs or parts of the body. Luckily, most treatment options are readily available here in China. However, treatment depends on both the kind of cancer as well as the stage.
“Basically, there are two stages of small cell lung cancer, namely, limited stage and extensive stage. The limited stage is potentially curable with chemotherapy and radiation,” according to Dr. Lau. “Then, there are four stages of non-small cell lung cancer. Stages 1 and 2 are potentially curable with surgery and sometimes followed by chemotherapy. Stage 3 is generally treated with chemotherapy and radiation. Stage 4 is treated with chemotherapy.”
It’s also important to know that there may be no apparent symptoms in the early stages of lung cancer. Yet, as the cancer progresses, symptoms such as unproductive coughing, coughing up blood and weight loss can be signs that it’s time to go to get checked out by a doctor.
Kicking butts
Considering cigarette smoking is the most common as well as the most definitively proven cause of lung cancer, it’s important for smokers—and those who love smokers enough to hope that they’ll kick the habit—to know what kinds of smoking cessation resources are available in Beijing.
According to Alfred Li, head pharmacist at International SOS, there are plenty of effective smoking cessation aids available here. The U.S. and EU have approved seven first line medical therapies for adults, including four that have also been approved in China and are readily available here. These pharmaceutical options include nicotine patches, nicotine gum, bupropriun tablets and varenicline tablets. Whereas nicotine patches and gum are nicotine replacement therapies available without a prescription, bupropion and varenicline alter brain chemistry, resulting in reduced severity of nicotine cravings and withdrawal symptoms. Buproprion and varenicline are also only available by prescription.
“Nicotine is a stimulant. It binds to stimulant receptors and produces a euphoric feeling, and people get addicted to that,” Li says. He explains that nicotine replacement therapies supplement the nicotine that is no longer being introduced to the body through smoking cigarettes, which allows a patient to wean him or herself off a nicotine dependency by gradually decreasing the amount of nicotine entering the body and, eventually, eliminating cravings.
Li urges those looking to quit smoking to consult a pharmacist or doctor prior to starting any of these therapies in order to determine an appropriate dosage, identify whether a patient is at risk for any adverse side effects and discuss how to properly use these products. A professional consultation will also help a smoker identify the proper course of treatment. For example, tobacco users smoking more than 10 cigarettes a day should begin with high dose nicotine patches for six weeks, followed by medium dose for two weeks and then finish with low dose for another two weeks. On the other hand, tobacco users smoking less than 10 cigarettes each day should start with medium dose nicotine patches for six weeks and finish with low dose for two weeks.
Furthermore, according to medical guidelines in the U.S., smoking is considered a chronic disease, or a behavior that is likely to recur even after someone stops. This is why Li suggests “ongoing intervention,” like talking to a doctor or pharmacist regularly about the process of quitting smoking and developing a strong social support group composed of family, friends and co-workers. Combining both medical and behavioral therapies will go a long way in someone’s quest to not just kick the habit, but kick it for good. He also recommends smokers in Beijing to visit the smoking cessation clinics at the No. 3 Hospital of Peking University, the Sino-Japan Friendship Hospital and Chaoyang Hospital, which he describes as better than most and fully-stocked in terms of available smoking cessation therapy options.
“There is evidence that a combined approach has a higher rate of success,” he says, pointing to behavior therapy, counseling and medication as the combination most likely to help someone become a non-smoker and stay that way.
The au naturel way
But besides the patches, pills and therapy sessions, some prefer the ancient Chinese approach of acupuncture. Marcus Gadau, an acupuncturist formerly with the San Fu Hospital affiliated with China-Japan Friendship Hospital, recommends acupuncture to treat the side effects of quitting smoking, such as weight gain and to recover lung function. “We see results of some sort with every patient,” says Gadau. “It’s personalized to every patient and it’s a very systematic approach.”
Small metal balls can be affixed to pressure points on the ear and pressed throughout the day to ease cravings for cigarettes and food. Additionally, pressure points can be hit in order to promote coughing, which promotes movement in the lungs, or to speed up the metabolism to curb weight gain that often comes with quitting smoking.
Herbalist Thomas Garran suggests using acupuncture in conjuction with herbal remedies. He strongly suggests Western herbs skullcap (Scutellaria lateriflora) and wild oat (Avena fatua) taken as a “tincture,” a medicine made by dissolving a drug of herb in alcohol, and the Chinese herbs yuan zhi (Polygala), suan zao ren (Zyziphus) and he huan hua (Albizia), and white ginseng. But he explains that there is no single herbal remedy to help people quit smoking—it varies from person to person. Garran also adds that no matter what anyone says or what they recommend, the smoker must want to quit. There’s no on-and-off switch that we can flick whenever we want, the only thing that he and other clinics, doctors and centers can offer is a helping hand to make the transition easier.
No matter the method, the important thing is quitting. It will significantly decrease the odds of developing lung cancer as well as a host of other smoking-related diseases and afflictions for smokers and non-smokers alike. It will also help keep moms and dads alive for as long as possible, and nobody needs statistics to know that this would be a welcomed trend.
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